Study: Screening malnourished children for TB in high-burden countries would boost detection

Fewer than half of countries with high rates of tuberculosis incidence surveyed in a recent study have guidelines recommending screening for the disease among children receiving services for malnutrition, even though having those guidelines, increasing case-finding among children, linking them to care, and tracking their contacts could lead to inroads against the leading infectious disease killer, according to authors of a report on the findings. The study gathered and analyzed malnutrition management guidelines from 17 countries with high rates of tuberculosis.

The report of the study, published in the International Union Against Tuberculosis and Lung Disease journal Public Health Action, notes that about 10 percent of the 10.4 million people who became sick with tuberculosis in 2015 were children under the age of 15, and that an estimated 210,000 children died of the disease that year. Still, diagnosis and treatment of the disease among children lags, with just 39 percent of cases of tuberculosis among children reported, the authors write. International tuberculosis experts have long recommended better integrating tuberculosis screening in primary health care settings and in settings providing services for conditions and diseases that put people at high risk for tuberculosis.

Settings where services for malnutrition are provided would be one of those settings, with a study cited in the report having led to estimates that more than a quarter of tuberculosis cases in the 22 countries with the highest burdens of tuberculosis were attributable to malnutrition. While undernourished children are at increased risk of dying from infectious diseases, being sick with an infectious disease, including tuberculosis, also increases risks of becoming malnourished, the authors write.

Still the authors, L.N. Patel of Vital Strategies and A.k. Detjen of UNICEF, found, just seven of the 17 countries surveyed recommend routine screening for tuberculosis among acutely malnourished children. Those recommendations, in turn, varied with guidelines ranging from recommendations to ask questions on tuberculosis-related symptoms and exposure, to guidance to provide specific diagnostic tests. While the survey did not obtain guidelines from all countries with high burdens of tuberculosis, it obtained guidelines from some of the highest burden countries including South Africa and India, where national guidelines do recommend screening for TB among patients with malnutrition, and Brazil, Pakistan and the Philippines where the most recently obtained guidelines did not.

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